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Prescription Drug Affordability Woes Grow for Americans

WASHINGTON, DCMore Americansespecially those with
chronic conditions such as diabetes, asthma and depression-are going without
prescription drugs because of cost concerns, according to a new national study
by the Center for Studying Health System Change (HSC).

Among all American adults, prescription drug access problems rose markedly
for adults with chronic conditions, increasing from 16.5 percent in 2001 to
18.3 percent in 2003. As a result, more than 14 million American adults with
chronic conditionsmore than half with incomes below 200 percent of the federal
poverty level, or $36,800 for a family of four in 2003could not afford all
of their prescriptions in 2003.

"Adults with chronic conditions were twice as likely as other adults to
have problems affording prescription drugs," said Paul B. Ginsburg, Ph.D.,
president of HSC, a nonpartisan policy research organization funded principally
by The Robert Wood Johnson Foundation.

The studys findings are based on HSCs Community Tracking Study Household
Survey, a nationally representative survey that asked people about their ability
to afford prescription medicines. In 2003, the survey included 36,500 adults
18 and older, while the 2001 survey included responses from 46,400 adults.

The proportion of all American adults reporting problems affording prescription
drugs also ticked up between 2001 and 2003, increasing from 12 percent to 12.8
percent. This small but statistically significant increase in affordability
problems likely resulted from higher prescribing rates and increased patient
cost sharing, according to the study.

In another indication that increased patient cost sharing contributes to prescription
affordability problems, the proportion of privately insured, working-age people
with chronic conditions who reported not filling at least one prescription because
of cost concerns increased from 12.7 percent to 15.2 percent between 2001 and
2003.

"As medical needs for prescription drugs continue to grow, its likely
that the proportion of working-age Americans, especially those with chronic
conditions, going without prescription drugs because of cost concerns will continue
to grow," said Marie Reed, M.H.S., an HSC health research analyst and study
author.

Low-income, uninsured working-age adults with chronic conditions were
most likely to have cost-related access problems, with nearly 60 percent reporting
they could not afford all their prescriptions in 2003. Nearly 40 percent of
chronically ill low-income people with public insurance, such as Medicaid, were
unable to fill at least one prescription because of cost concerns. And, in 2003,
the rate of access problems for low-income, privately insured working-age adults
with chronic conditions was similar to that faced by those with public insurance-nearly
35 percent had cost-related unmet prescription drug needs. Among low-income
elderly Medicare beneficiaries with chronic conditions, 17 percent reported
being unable to fill at least one prescription.

Elderly Medicare beneficiaries living with chronic conditions who
had private supplemental coverage-employer-sponsored or Medigap-were not more
likely to report problems affording their prescription in 2003 than in 2001.
But prescription drug access problems did increase for beneficiaries lacking
supplemental private coverage, growing from 12.4 percent in 2001 to 16.4 percent
in 2003.

Regardless of insurance coverage, about half of low-income working-age
adults with chronic conditions and an unmet prescription drug need paid more
than 5 percent of their incomes for medical expenses in 2003. And more than
half of these-nearly 1.8 million working-age adults-paid more than 10 percent
of their incomes for medical expenses and still were unable to purchase all
of their prescriptions. These estimates are conservative since payments for
insurance premiums were not included as out-of-pocket medical expenses.

Privately insured working-age blacks with chronic conditions were
nearly twice as likely as whites to not be able to afford all of their prescriptions-22
percent vs. 13 percent-in 2003. Similarly, 17 percent of black elderly Medicare
beneficiaries reported problems affording prescription drugs compared with 9
percent of white beneficiaries.

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The Center for Studying Health System Change is a nonpartisan policy research
organization committed to providing objective and timely research on the nations
changing health system to help inform policy makers and contribute to better
health care policy. HSC, based in Washington, D.C., is funded principally by
The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy
Research, Inc.